Congenital, Paradoxical Lower Eyelid Retraction on Upgaze

PURPOSE: Active lower eyelid retraction on upgaze is a rarely described finding. The purpose of this study is to describe the clinical and operative findings in two patients with this unique eyelid movement disorder. METHODS: The authors identified active, unilateral lower eyelid retraction on upgaze in two patients who had no other ocular or systemic abnormalities. RESULTS: Surgical extirpation of the lower eyelid retractor complex was carried out in both cases. During one of the procedures, performed under local anesthesia, the lower eyelid retractors were observed to retract actively on upgaze. Postoperatively, lower eyelid retraction on upgaze was not present in either case. CONCLUSIONS: The authors are aware of only one other case report describing active, paradoxical lower eyelid retraction on upgaze. The mechanism of eyelid retraction in this previous report and in the two patients described herein is not known. The authors postulate that these unique cases may represent a previously unrecognized form of congenital, aberrant innervation of the oculomotor nerve.